Taking On "The Big O" for Women

Joe can't reach orgasm. Old Little Joe just isn't performing the way he used to. How long will it be before Joe's thinking crisis: doctor ... Viagra ... fix it? Maybe a week.

But what if Joe's wife, Jane, can't have an orgasm? She does a Meg Ryan-in-the-deli "I'll have what she's having," and nobody talks about it and no one's the wiser.

Until now. Finally, the art and science of The Big O for women is getting long-overdue attention -- from doctors, from sex therapists, from the media, and with any luck, from women's partners. Women's sexual pleasure has become big business. There's even talk of a Viagra for women.

Some studies estimate that more than half of the women over 40 in the U.S. have sexual complaints, and a survey published in TheJournal of the American Medical Association in 1999 showed that 43% of American women -- of all ages -- suffer from some sexual dysfunctions -- a much higher rate than the 31% reported for men.

Not everybody buys those numbers -- some women think the researchers weren't asking the right questions -- but no one will dispute that for many of us, sex isn't the E-ticket ride at Disneyland that the latest issue of Cosmo bills it to be. And it's not necessarily "all in your mind." Problems with enjoying sex and reaching orgasm can stem from a host of physical causes, says Jennifer Berman, MD, a urologist. "Hormonal abnormalities, problems with estrogen or testosterone, medications like antidepressants, prior pelvic surgery or hysterectomy, illnesses such as diabetes, or high blood pressure and high cholesterol are just a few of the possible causes."

With her sister Laura, a sex therapist,
Berman co-directs the Female Sexual Medicine Center (FSMC) at UCLA Medical
Center, and she founded the Network for Excellence in Women's Sexual Health. They take a "mind-body" approach to sexual health -- exploring everything from couples therapy to new research on "nerve-sparing hysterectomy," surgery designed to preserve a woman's sexual function in the same way nerve-sparing prostatectomies do for men.

What Do We Mean by Good Sex?

Hold on a minute, says Gina Ogden, PhD, a sex therapist in Cambridge, Mass., and author of Women Who Love Sex: An Inquiry into the Expanding Spirit of Women's Erotic Experience. Before we start trying to fix women's sexual dysfunction, maybe we'd better figure out just what constitutes women's sexual function. "The idea seems to be that sex is all or mainly about being physical, and that the dysfunctions are mainly the dysfunctions of intercourse," she says. "Sex is more than physical, therefore sexual dysfunction is more than physical. Maybe your low sexual desire is because your mate is not meeting your needs on a variety of levels. If you go to a sex therapist who says, 'Here's how he can have an erection and here's how you can lubricate,' that may not be the whole answer."

So what's the whole answer? "Sexual response is incredibly complex. I don't mean that it has to be a lot of work or it's like a crossword puzzle or something. But there are many elements to sex working," Ogden says.

Watching Samantha, Carrie, and the girls chart new orgasmic territory on Sex and the City may have taught us that we have the right to ask for what we want, but that message may have also come with some undue pressure. "Most women feel their fears and ignorance are unique to them. They think: 'Everybody else is ****ing like a bunny and hanging from the chandeliers, except me.' That's the result of the marketing mentality," says Leonore Tiefer, a clinical associate professor of psychiatry at New York University School of Medicine and the founder of the "New View" campaign (www.fsd-alert.org). "The first step is to share and find out that everybody else doesn't know anything either."

So maybe you want peel-you-off-the-ceiling orgasms. Maybe you want tenderness and cuddling. Maybe -- gasp -- you want both. Or maybe your dark, dirty secret is that you don't really care all that much about sex. "There's nothing natural about one script vs. another script. It's totally up to you," says Tiefer. "It's like dance or a cuisine -- something you can do whatever you want with. But like fine cuisine, you can't expect to walk into the kitchen and whip up a souffle if you don't know what you're doing. If you want to be good at sex, you have to study and practice."

Getting Yours: Tips for a Better Sex Life

Remember: "There is no normal," says Berman. "Sexual dysfunction is defined by each woman. If she's unhappy with her sexual response, that's what matters.

Know that it's totally OK to have sex for your own reasons. "Having sex for just sex is fine, if that's what you want. Sex only in a committed relationship is fine, if that's what you want," Berman says. "Some women have no libido, no orgasms, and couldn't care less. That's fine, too."

Understand those reasons. "Ask yourself what sex means in your life. Is it about your self-image? Is it about nurturing -- feeling loved and accepted? Is it about power?" asks Ogden. "Maybe it's very simply about pleasure, about feeling good, which is very scary in this culture."

Involve your partner. "If you have a male partner,
don't let him get away with saying that cuddling for its own sake is 'just for
women.' There are men who want that, too," says Ogden. "It doesn't mean that
you're half a man because you like cuddling as much as sex. This is America's
best-kept sexual secret."